Effects of Trigger Point Dry Needling for the Management of Knee Pain Syndromes: A Systematic Review and Meta-Analysis

Background: To evaluate the effect of trigger point dry needling alone or as an adjunct with other interventions on pain and related disability in people with knee pain. Methods: Several electronic databases were searched for randomized controlled trials where at least one group received dry needling for knee pain. Studies had to include human subjects and collect outcomes on pain and pain-related disability in musculoskeletal knee pain. Data were extracted by two reviewers. The risk of bias was assessed by the Cochrane Guidelines, methodological quality was assessed with the Physiotherapy Evidence Database (PEDro) score, and the quality of evidence by using the GRADE approach. Standardized mean differences (SMD) were calculated. Results: Ten studies (six patellofemoral pain, two knee osteoarthritis, two post-surgery knee pain) were included. The meta-analysis found moderate effect sizes of dry needling for reducing pain (SMD −0.53, 95% CI −0.87 to −0.19) and improving related disability (SMD −0.58, 95% CI −1.08 to −0.09) as compared to a comparison group at short-term. The main effect was observed for patellofemoral pain (SMD −0.64, 95% CI −1.17 to −0.11). No significant effects were observed at mid- or long-term follow-ups. The risk of bias was generally low, but the heterogenicity and the imprecision of the results downgraded the level of evidence. Conclusion: Low to moderate evidence suggests a positive effect of trigger point dry needling on pain and related disability in patellofemoral pain, but not knee osteoarthritis or post-surgery knee pain, at short-term. More high-quality trials investigating long-term effects are clearly needed.

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Exercise interventions in lateral elbow tendinopathy have better outcomes than passive interventions, but the effects are small: a systematic review and meta-analysis of 2123 subjects in 30 trials

British Journal of Sports Medicine ◽

10.1136/bjsports-2020-102525 ◽

2020 ◽

pp. bjsports-2020-102525

Author(s):

Stefanos Karanasios ◽

Vasileios Korakakis ◽

Rod Whiteley ◽

Ioannis Vasilogeorgis ◽

Sarah Woodbridge ◽

...

Keyword(s):

Systematic Review ◽

Meta Analysis ◽

Risk Of Bias ◽

Short Term ◽

Lateral Elbow ◽

Long Term Follow Up ◽

Wait And See ◽

Lateral Elbow Tendinopathy

ObjectiveTo evaluate the effectiveness of exercise compared with other conservative interventions in the management of lateral elbow tendinopathy (LET) on pain and function.DesignSystematic review and meta-analysis.MethodsWe used the Cochrane risk-of-bias tool 2 for randomised controlled trials (RCTs) to assess risk of bias and the Grading of Recommendations Assessment, Development and Evaluation methodology to grade the certainty of evidence. Self-perceived improvement, pain intensity, pain-free grip strength (PFGS) and elbow disability were used as primary outcome measures.Eligibility criteriaRCTs assessing the effectiveness of exercise alone or as an additive intervention compared with passive interventions, wait-and-see or injections in patients with LET.Results30 RCTs (2123 participants, 5 comparator interventions) were identified. Exercise outperformed (low certainty) corticosteroid injections in all outcomes at all time points except short-term pain reduction. Clinically significant differences were found in PFGS at short-term (mean difference (MD): 12.15, (95% CI) 1.69 to 22.6), mid-term (MD: 22.45, 95% CI 3.63 to 41.3) and long-term follow-up (MD: 18, 95% CI 11.17 to 24.84). Statistically significant differences (very low certainty) for exercise compared with wait-and-see were found only in self-perceived improvement at short-term, pain reduction and elbow disability at short-term and long-term follow-up. Substantial heterogeneity in descriptions of equipment, load, duration and frequency of exercise programmes were evident.ConclusionsLow and very low certainty evidence suggests exercise is effective compared with passive interventions with or without invasive treatment in LET, but the effect is small.PROSPERO registration numberCRD42018082703.

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Effects of Trigger Point Dry Needling for Nontraumatic Shoulder Pain of Musculoskeletal Origin: A Systematic Review and Meta-Analysis

Physical Therapy ◽

10.1093/ptj/pzaa216 ◽

2020 ◽

Author(s):

Marcos J Navarro-Santana ◽

Guido F Gómez-Chiguano ◽

Joshua A Cleland ◽

Jose L Arias-Buría ◽

César Fernández-de-las-Peñas ◽

...

Keyword(s):

Clinical Trials ◽

Pain Intensity ◽

Shoulder Pain ◽

Trigger Point ◽

Meta Analysis ◽

Dry Needling ◽

Short Term ◽

Positive Effects ◽

Evidence Level ◽

Quality Evidence

Abstract Objective The purpose of this study was to evaluate the effects of trigger point (TrP) dry needling alone or as an adjunct to other interventions on pain intensity and related disability in nontraumatic shoulder pain. Methods Ten databases were searched from inception to January 2020 for randomized clinical trials in which at least 1 group received TrP dry needling for shoulder pain of musculoskeletal origin with outcomes collected on pain intensity and related disability. Data extraction including participant and therapist details, interventions, blinding strategy, blinding assessment outcomes, and results were extracted by 2 reviewers. The risk of bias (RoB, Cochrane Guidelines), methodological quality (PEDro score), and evidence level (GRADE approach) were assessed. The search identified 551 publications with 6 trials eligible for inclusion. Results There was moderate quality evidence that TrP dry needling reduces shoulder pain intensity with a small effect (MD = −0.49 points, 95% CI = −0.84 to −0.13; SMD = −0.25, 95% CI = −0.42 to −0.09) and low quality evidence that TrP dry needling improves related disability with a large effect (MD = −9.99 points, 95% CI -15.97 to −4.01; SMD = −1.14, 95% CI -1.81 to −0.47) as compared to a comparison group. The effects on pain were only found at short-term. The RoB was generally low, but the heterogenicity of the results downgraded the evidence level. Conclusions Moderate- to low-quality evidence suggests positive effects of TrP dry needling for pain intensity (small effect) and pain-related disability (large effect) in nontraumatic shoulder pain of musculoskeletal origin, mostly at short term. Future clinical trials investigating long-term effects are needed. Impact Dry needling is commonly used for the management of musculoskeletal pain. This is the first meta-analysis to examine the effects of dry needling on nontraumatic shoulder pain.

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POS1099 EFFICACY OF INTRA-ARTICULAR CORTICOSTEROID INJECTIONS IN KNEE OSTEOARTHRITIS: A SYSTEMATIC REVIEW AND META-ANALYSIS OF RANDOMIZED CONTROLLED TRIALS

Annals of the Rheumatic Diseases ◽

10.1136/annrheumdis-2021-eular.3291 ◽

2021 ◽

Vol 80 (Suppl 1) ◽

pp. 829.2-830

Author(s):

A. Najm ◽

A. Alunno ◽

C. Weill ◽

J. Gwinnutt ◽

F. Berenbaum

Keyword(s):

Knee Osteoarthritis ◽

Meta Analysis ◽

Controlled Trials ◽

Medium Term ◽

Short Term ◽

Knee Oa ◽

Randomized Controlled ◽

And Function

Background:Knee osteoarthritis (OA) is a frequent degenerative disease representing an important health and economic burden. Symptomatic medical treatments available include intra-articular (IA) injections of corticosteroids (GC) but their efficacy is debated. In addition, safety signals regarding cartilage damage with IA GC have been highlighted in a few studies.Objectives:To perform a meta-analysis of studies assessing IA GC efficacy and safety in knee OA.Methods:A systematic literature review and a meta-analysis of randomized controlled trials (RCTs) assessing the effect of GC IA injections versus other interventions (IA Hyaluronic Acid, IA placebo, IA NSAID, oral NSAID or physiotherapy) in knee OA was performed. The effect of the interventions on pain and function were extracted from the single studies and pooled and are presented as short term (<6weeks), medium term (6-24 weeks) and long term (>24 weeks) follow-up period. Standardized mean differences (SMD) are reported.Results:Of 520 studies screened, 23 were included in the SLR and 14 subsequently included in the MA. While IA GC showed a superior effect compared to control on both pain (SMD -0.61 (95% CI -1,25, 0.03)) and function (SMD -1.02 (95% CI -2.14, 0.10)) in short term follow-up; long term follow-up analysis favored controls (IA HA, IA NSAID, physiotherapy) for both pain (SMD 0.68 (95% CI -0.11, 1.47)) and function (SMD 0.88 (95% CI -0.36, 2.12) outcomes (Figure 1). No difference was found between interventions in the medium term. Safety data were reported in 18/23 studies (n= 1936/2314 patients); and side effects were reported as follows: arthralgia (69 IA GC patients, 146 IA HA patients, and 20 saline patients); site injection pain (7 in the IA GC group, 2 in the IA saline group, 14 in the IA HA group); 16 post injection knee swelling without signs of septic arthritis in the IA GC group and 24 in the IA HA group. In one study assessing cartilage effects of GCs, the rate of cartilage loss was greater in the GC group with a reduction of cartilage thickness at 2 year compared to placebo group. No difference was observed in the progression of cartilage denudation or bone marrow lesion. On the contrary, another study showed no effect of injections on the cartilage structure.Conclusion:We demonstrate in this work that IA GC injections reduce pain and improve function in the early phase (≤6 weeks) of treatment. In the long term (≥24 weeks), other intervention such as IA HA injections or physiotherapy seem to be more efficient, but this effect was largely driven by single studies with large effect sizes and the comparators were heterogeneous.Figure 1.Knee pain outcome at short term (≤6weeks) (A), medium term (>6 & <24 weeks) (B), and long term (≥24 weeks) (C) follow up.Disclosure of Interests:None declared.

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Effects of trigger point dry needling on lateral epicondylalgia of musculoskeletal origin: a systematic review and meta-analysis

Clinical Rehabilitation ◽

10.1177/0269215520937468 ◽

2020 ◽

Vol 34 (11) ◽

pp. 1327-1340 ◽

Cited By ~ 1

Author(s):

Marcos J Navarro-Santana ◽

Jorge Sanchez-Infante ◽

Guido F Gómez-Chiguano ◽

Joshua A Cleland ◽

Ibai López-de-Uralde-Villanueva ◽

...

Keyword(s):

Pain Sensitivity ◽

Meta Analysis ◽

Risk Of Bias ◽

Dry Needling ◽

Short Term ◽

Pain Thresholds ◽

Pressure Pain ◽

Pressure Pain Thresholds ◽

Lateral Epicondylalgia ◽

Comparative Group

Objective: This meta-analysis evaluated the effect of dry needling alone or combined with other treatment interventions on pain, related-disability, pressure pain sensitivity, and strength in people with lateral epicondylalgia of musculoskeletal origin. Data Sources: MEDLINE, CINAHL, PubMed, PEDro, Cochrane Library, SCOPUS and Web of Science databases from their inception to 5 April 2020. Review Methods: Randomized controlled trials collecting outcomes on pain, related-disability, pressure pain thresholds, or strength where one group received dry needling for lateral epicondylalgia of musculoskeletal origin. The risk of bias was assessed by the Cochrane Guidelines, methodological quality was assessed with the PEDro score, and the quality of evidence by using the GRADE approach. Results: Seven studies including 320 patients with lateral epicondylalgia were included. The meta-analysis found that dry needling reduced pain intensity (SMD ‒1.13, 95%CI ‒1.64 to ‒0.62) and related-disability (SMD ‒2.17, 95%CI ‒3.34 to ‒1.01) with large effect sizes compared to a comparative group. Dry needling also increased pressure pain thresholds with a large effect size (SMD 0.98, 95%CI 0.30 to 1.67) and grip strength with a small size effect (SMD 0.48, 95%CI 0.16 to 0.81) when compared to a comparative group. The most significant effect was at short-term. The risk of bias was generally low, but the heterogenicity of the results downgraded the evidence level. Conclusion: Low to moderate evidence suggests a positive effect of dry needling for pain, pain-related disability, pressure pain sensitivity and strength at short-term in patients with lateral epicondylalgia of musculoskeletal origin. Level of Evidence: Therapy, level 1a. Registration number: OSF Registry - https://doi.org/10.17605/OSF.IO/ZY3E8

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A meta-analysis into the effect of lateral-wedged insoles with subtalar strapping versus traditional insoles in adults with medial knee osteoarthritis.

South African Journal of Physiotherapy ◽

10.4102/sajp.v67i1.37 ◽

2011 ◽

Vol 67 (1) ◽

Author(s):

L. Duvenhage ◽

T. Mushaike ◽

N. Parker ◽

L. Swartz ◽

M. Rensburg ◽

...

Keyword(s):

Knee Osteoarthritis ◽

Meta Analysis ◽

Cochrane Library ◽

Narrative Form ◽

Short Term ◽

Medial Knee ◽

Medial Knee Osteoarthritis ◽

Knee Oa ◽

Randomised Controlled

To systematically identify, collate, and analyze the current available evidence for the effectiveness of lateral-wedged insoles, with subtalar strapping, on reducing pain, improving function and improving the femoral-tibial angle (FTA), in adults with medial knee osteoarthritis compared to traditional insoles without subtalar strapping.Six computerised databases, namely Cochrane Library, CiNAHL, PEDro, BIOMED central, PubMed and ScienceDirect were searched. The included articles were then all rated using the PEDro scale to determine their meth-odological quality. Homogeneous data were pooled in a meta-analysis using Review Manager (REVMAN) software. Where statistical pooling of the results was not possible, findings were summarised in narrative form. Three randomised controlled trials were selected for this review. The average PEDro score was 5.7. A meta-analysis demonstrated that lateral-wedged insoles with subtalar strapping significantly reduced pain in the short-term (p=0.004). The review found that lateral-wedge insoles with subtalar strapping significantly decreased pain in the short-term and seemed to have a positive effect on the FTA in the long-term, when compared to traditional insoles without subtalar strapping. The lateral-wedge insole with subtalar strapping may provide a financially feasible adjunctive self-management treatment for knee OA and should be considered before invasive procedures such as surgery.

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Anticholinergic drugs and incident dementia, mild cognitive impairment and cognitive decline: a meta-analysis

Age and Ageing ◽

10.1093/ageing/afaa090 ◽

2020 ◽

Vol 49 (6) ◽

pp. 939-947 ◽

Cited By ~ 1

Author(s):

Nina T Pieper ◽

Carlota M Grossi ◽

Wei-Yee Chan ◽

Yoon K Loke ◽

George M Savva ◽

...

Keyword(s):

Cognitive Impairment ◽

Mild Cognitive Impairment ◽

Cognitive Decline ◽

Meta Analysis ◽

Anticholinergic Drug ◽

Risk Of Bias ◽

Anticholinergic Drugs ◽

Short Term ◽

Incident Dementia

Abstract Background the long-term effect of the use of drugs with anticholinergic activity on cognitive function remains unclear. Methods we conducted a systematic review and meta-analysis of the relationship between anticholinergic drugs and risk of dementia, mild cognitive impairment (MCI) and cognitive decline in the older population. We identified studies published between January 2002 and April 2018 with ≥12 weeks follow-up between strongly anticholinergic drug exposure and the study outcome measurement. We pooled adjusted odds ratios (OR) for studies reporting any, and at least short-term (90+ days) or long-term (365+ days) anticholinergic use for dementia and MCI outcomes, and standardised mean differences (SMD) in global cognition test scores for cognitive decline outcomes. Statistical heterogeneity was measured using the I2 statistic and risk of bias using ROBINS-I. Results twenty-six studies (including 621,548 participants) met our inclusion criteria. ‘Any’ anticholinergic use was associated with incident dementia (OR 1.20, 95% confidence interval [CI] 1.09–1.32, I2 = 86%). Short-term and long-term use were also associated with incident dementia (OR 1.23, 95% CI 1.17–1.29, I2 = 2%; and OR 1.50, 95% CI 1.22–1.85, I2 = 90%). ‘Any’ anticholinergic use was associated with cognitive decline (SMD 0.15; 95% CI 0.09–0.21, I2 = 3%) but showed no statistically significant difference for MCI (OR 1.24, 95% CI 0.97–1.59, I2 = 0%). Conclusions anticholinergic drug use is associated with increased dementia incidence and cognitive decline in observational studies. However, a causal link cannot yet be inferred, as studies were observational with considerable risk of bias. Stronger evidence from high-quality studies is needed to guide the management of long-term use.

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Is Dry Needling Effective for the Management of Plantar Heel Pain or Plantar Fasciitis? An Updated Systematic Review and Meta-analysis

Pain Medicine ◽

10.1093/pm/pnab114 ◽

2021 ◽

Author(s):

Luis Llurda-Almuzara ◽

Noé Labata-Lezaun ◽

Toni Meca-Rivera ◽

Marcos J Navarro-Santana ◽

Joshua A Cleland ◽

...

Keyword(s):

Pain Intensity ◽

Plantar Fasciitis ◽

Meta Analysis ◽

Heel Pain ◽

Risk Of Bias ◽

Dry Needling ◽

Level Of Evidence ◽

Plantar Heel Pain ◽

Quality Evidence

Abstract Objective Dry needling is commonly used for the management of plantar fasciitis. This meta-analysis evaluated the effects of dry needling over trigger points (TrPs) associated with plantar heel pain on pain intensity and related disability or function. Methods Electronic databases were searched for randomized controlled trials where at least one group received dry needling, not acupuncture, for TrPs associated with plantar heel pain and collected outcomes on pain intensity and related-disability. The risk of bias (RoB) was assessed using the Cochrane risk of bias tool, methodological quality was assessed with PEDro score, and the level of evidence is reported using the GRADE approach. Between-groups mean differences (MD) and standardized mean difference (SMD) were calculated. Results The search identified 297 publications with 6 trials eligible for inclusion. The meta-analysis found low quality evidence that TrP dry needling reduces pain intensity at short term (MD -1.70 points, 95%CI -2.80 to -0.60; SMD -1.28, 95%CI -2.11 to -0.44) and moderate quality evidence for improving pain intensity (MD -1.77 points, 95%CI -2.44 to -1.11; SMD -1.45, 95%CI -2.19 to -0.70) and related-disability (SMD -1.75, 95% CI -2.22 to -1.28) at long-term compared to a comparison group. The RoB of the trials was generally low, but the heterogeneity of the results downgraded the level of evidence. Discussion Moderate to low evidence suggests a positive effect of TrP dry needling for improving pain intensity and pain-related disability in patients with plantar heel pain of musculoskeletal origin at short- and long-term, respectively. Current results should be considered with caution due to the small number of trials.

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Can obesity and physical activity predict outcomes of elective knee or hip surgery due to osteoarthritis? A meta-analysis of cohort studies

BMJ Open ◽

10.1136/bmjopen-2017-017689 ◽

2018 ◽

Vol 8 (2) ◽

pp. e017689 ◽

Cited By ~ 14

Author(s):

Daniel Pozzobon ◽

Paulo H Ferreira ◽

Fiona M Blyth ◽

Gustavo C Machado ◽

Manuela L Ferreira

Keyword(s):

Physical Activity ◽

Systematic Review ◽

Clinical Outcomes ◽

Knee Arthroplasty ◽

Meta Analysis ◽

Short Term ◽

Postsurgical Complications ◽

Pain Disability ◽

Post Surgery

ObjectiveThe aim of this study was to systematically review the literature to identify whether obesity or the regular practice of physical activity are predictors of clinical outcomes in patients undergoing elective hip and knee arthroplasty due to osteoarthritis.DesignSystematic review and meta-analysis.Data source and eligibility criteriaA systematic search was performed on the Medline, CINAHL, EMBASE and Web of Science electronic databases. Longitudinal cohort studies were included in the review. To be included, studies needed to have assessed the association between obesity or physical activity participation measured at baseline and clinical outcomes (ie, pain, disability and adverse events) following hip or knee arthroplasty.Data extractionTwo independent reviewers extracted data on pain, disability, quality of life, obesity, physical activity and any postsurgical complications.Results62 full papers were included in this systematic review. From these, 31 were included in the meta-analyses. Our meta-analysis showed that compared to obese participants, non-obese participants report less pain at both short term (standardised mean difference (SMD) −0.43; 95% CI −0.67 to −0.19; P<0.001) and long term post-surgery (SMD −0.36; 95% CI −0.47 to −0.24; P<0.001), as well as less disability at long term post-surgery (SMD −0.32; 95% CI −0.36 to −0.28; P<0.001). They also report fewer postsurgical complications at short term (OR 0.48; 95% CI 0.25 to 0.91; P<0.001) and long term (OR 0.55; 95% CI 0.41 to 0.74; P<0.001) along with less postsurgical infections after hip arthroplasty (OR 0.33; 95% CI 0.18 to 0.59; P<0.001), and knee arthroplasty (OR 0.42; 95% CI 0.23 to 0.78; P=0.006).ConclusionsPresurgical obesity is associated with worse clinical outcomes of hip or knee arthroplasty in terms of pain, disability and complications in patients with osteoarthritis. No impact of physical activity participation has been observed.PROSPERO registration numberCRD42016032711.

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SHORT-TERM EFFECTS OF TRIGGER POINT DRY NEEDLING ON PAIN AND DISABILITY IN SUBJECTS WITH PATELLOFEMORAL PAIN SYNDROME

International Journal of Sports Physical Therapy ◽

10.26603/ijspt20180462 ◽

2018 ◽

Vol 13 (3) ◽

pp. 462-473 ◽

Cited By ~ 6

Author(s):

Thomas G. Sutlive ◽

Andrew Golden ◽

Kristin King ◽

William B. Morris ◽

John E. Morrison ◽

...

Keyword(s):

Trigger Point ◽

Pain Syndrome ◽

Patellofemoral Pain Syndrome ◽

Patellofemoral Pain ◽

Dry Needling ◽

Short Term ◽

Short Term Effects

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LIPUS Setting and Combined Effect With Therapeutic Exercise for Knee Osteoarthritis: A Systematic Review

10.21203/rs.3.rs-121886/v1 ◽

2020 ◽

Author(s):

Masashi Kitano ◽

Yuse Okawa ◽

Hirohisa Kawahata ◽

Shintarou Kudo

Keyword(s):

Knee Osteoarthritis ◽

Knee Pain ◽

Meta Analysis ◽

Exercise Group ◽

Combined Effect ◽

Therapeutic Exercise ◽

Irradiation Site ◽

Knee Oa ◽

Irradiation Intensity

Abstract [PURPOSE] Knee osteoarthritis (OA) is a chronic progressive disorder characterized by pain and decreased joint function. In the conservative treatment for the knee OA, the physiotherapy is known to be a common intervention. Recently, low-intensity pulsed ultrasound therapy (LIPUS) which has an effect on knee pain of knee OA has been used with therapeutic exercise. However, the combined effect of LIPUS with therapeutic exercise did not have enough evidence.This study was conducted to assess both setting off the LIPUS and combined effect of the therapeutic exercise in the Knee OA.[METHODS] PubMed, PEDro, CENTRAL were searched for RCTs on published before September 2019. The irradiation intensity, irradiation site, and treatment period of LIPUS were examined. Meta-analysis was performed to analyze the short and long term combined effect which was LIPUS with therapeutic exercise on the VAS score. Statistical calculations of both LIPUS with therapeutic exercise group and only therapeutic exercise group were compared from detailed data of the all eligible studies [RESULTS] Seven RCTs were eligible. Both irradiation intensity and site were varied. Three RCTs were included in the meta-analysis, involving a total of 210 knees. There was no significant improvement in pain in the LIPUS with therapeutic exercise (LIPUS) group compared with the therapeutic exercise group in short-term (MD; -6.86, 95% CI; -18.70 to 4.99 , I2 = 74%, heterogeneity: P = 0.02) and long-term (MD; -16.01 95% CI; -32.03 to 0.01, I2 = 82%, heterogeneity: P = 0.004) effects.[CONCLUSIONS]We did not find consistent evidence of the effects of combined to LIPUS and therapeutic exercise for Knee OA. Because, selected trials were varied in intensity and irradiation site and treatment durations, which might contribute to the existence of heterogeneity. Furthermore, there were few RCTs that resulted in knee joint function.The LIPUS combined therapeutic exercise found no significant decrease the knee pain than therapeutic exercise. Therefore, RCTs were recommended by well-designed intensity and irradiation site.

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